Loading...

ACE OF BIRMINGHAM - MEDICAL RELEASE FORM

I fully understand that ACE of Birmingham and staff are not physicians or medical practitioners of any kind. With the above in mind, I hereby release the staff at ACE of Birmingham to render temporary first aid to my child or children in the event of any injury or illness, and if deemed necessary by the staff at ACE of Birmingham, to call a doctor and seek medical help, including transportation to any health care facility or hospital, or the calling of an ambulance for said child should the staff at ACE of Birmingham deem it necessary.

We, the staff at ACE of Birmingham, recognize our obligation to make our clients and their parents aware of the risks and hazards associated with the sport of cheerleading. Competitors may suffer injuries, possibly minor, serious or catastrophic in nature. These activities can be dangerous and can lead to injury. It is the parents who should make their children aware of the possibility of injury and encourage their children to follow all the safety rules and coaches’ instructions.

The undersigned agree, ACE of Birmingham and its’ staff members are not responsible for injuries sustained by any cheerleader during the course of tumbling, stunting, cheerleading, or dancing in which he/she may participate or while traveling to or from the event. With the above in mind, and being fully aware of the risks and possibility of injury involved, I consent to have my child or children participate in the programs offered by ACE of Birmingham. I, my heirs, executors, and other representatives, waive and release all rights and claims for damages that I or my child/children may have against ACE of Birmingham and or its’ representatives whether paid or volunteer. I also affirm that I now have and will continue to provide hospitalization, health and accident insurance coverage that I consider adequate for both my child’s protection and my own protection.

APPEARANCE CLAUSE

Permission is granted to use my son/daughter’s picture or image in future advertisement and literature for ACE of Birmingham, ACE Cheer Company and events sponsored and conducted by them. I have read and agree to the above release and appearance clause.

  COVID-19 ASSUMPTION OF RISK, WAIVER AND RELEASE OF LIABILITY

As used herein, “ACE” shall refer to ACE All-Stars of Alabama, LLC, ACE of Birmingham, and their officers, agents, owners, members, directors, employees, representatives, successors and assigns.  “ACE Premises” shall mean the ACE gym facility and surrounding outdoor areas, including the ACE driveway and parking lot and means of entry and exit to and from the facility and parking lot. The participant athlete referred to as “My Athlete”. 

The World Health Organization has declared the novel coronavirus (COVID-19) a worldwide pandemic capable of transmission from person-to-person. ACE will use reasonable efforts to promote the health and safety of ACE athletes.  However, because of the nature of the virus, ACE cannot and will not guarantee the safety of those persons participating in activities on the ACE premises.

I understand that ACE has been permitted by the government to reopen its doors under certain limited conditions, but the risk of being infected with the COVID-19 virus still exists to me, My Athlete, members of our families and others who access the ACE Premises. I understand the COVID-19 virus has a long incubation period during which carriers of the virus may not show symptoms and still be highly contagious. Some of the carriers of the virus never show any symptoms. It is therefore impossible to determine who has it and who does not. I understand that all of the health risks of the COVID-19 are not known at this time, but I understand that the COVID-19 virus is highly contagious.  I further understand that COVID-19 may cause serious and perhaps lifelong health hazards and can be fatal.

Notwithstanding the precautions taken by and disinfecting done by ACE, I understand that due to volume of athletes and employees using the ACE Premises, the frequency of visits by individuals to ACE, the characteristics of the virus, and the characteristics of the ACE facilities, My Athlete and I (if present or located on the ACE Premises or around My Athlete after his/her presence at ACE) has an elevated risk of contracting the virus simply by being on the ACE Premises.

EVERY TIME My Athlete enters the ACE Premises, I agree that the following statements are true and correct to the best of my knowledge: 

  • My Athlete does not have the COVID-19 virus or any of the symptoms thereof (fever above 99°, shortness of breath, loss of sense of taste or smell, dry cough, or sore throat)
  • My Athlete has not been tested for the COVID-19 virus, or if My Athlete has been tested for it, My Athlete has received negative results. 
  • My Athlete has not been around anyone with COVID-19 symptoms in the past 14 days to my knowledge. 
  • My Athlete does not live with and has not been around anyone who is sick or quarantined. 
  • My Athlete has not traveled by commercial airline, bus, or train within the past 14 days.
  • I verify that My Athlete will comply with all COVID-19 policies currently put into practice by ACE, and all recommendations of the CDC. 
  • I agree to immediately notify ACE, in writing, if My Athlete or someone living in any place where My Athlete resides or has been present tests positive for COVID-19, or shows symptoms of COVID-19. 
  • I agree that My Athlete will not enter the ACE Premises if I cannot agree to any of the above statements on any given day or time.

Understanding the above, I agree on behalf of myself and My Athlete, that by participating in activities at ACE or simply being present at the ACE Premises, My Athlete, I and others who are present at ACE Premises with us may be at risk of contracting COVID-19. With full knowledge of the risks associated with COVID-19, I, on behalf of myself and my minor children and/or wards, our heirs, executors, and personal representatives, hereby release, waive, and discharge ACE, its officers, members, owners, agents, directors, employees, independent contractors, affiliates, representatives, successors and assigns from any and all liability, claims, demands, actions, and causes of action whatsoever, directly or indirectly, arising out of or related to any loss, damage, injury, or death, that may be sustained by My Athlete or me related to COVID-19 while participating in any activity while on, in, or around the ACE Premises, or while using the facilities that may lead to unintentional exposure or harm due to COVID-19. I further agree to indemnify, defend, and hold harmless ACE from and against any and all costs, expenses, damages, losses, and or liabilities or claims arising whether directly or indirectly from or related to any such claims made by or against any of the released parties above.

By electronically signing below, I acknowledge that I have read the foregoing liability release waiver and understand its contents; that I am at least 19 years old and fully competent and that I am the parent or legal guardian of My Athlete and authorized to give my consent on my behalf and/or on behalf of My Athlete; that no other authorization or approval is needed to execute this Agreement (including from any other parent or legal guardian or other representative), and that I have been sufficiently informed of the risks involved and give my voluntary consent to this waiver, free from any inducement or representation.  

I fully understand that ACE of Birmingham and staff are not physicians or medical practitioners of any kind. With the above in mind, I hereby release the staff at ACE of Birmingham to render temporary first aid to my child or children in the event of any injury or illness, and if deemed necessary by the staff at ACE of Birmingham, to call a doctor and seek medical help, including transportation to any health care facility or hospital, or the calling of an ambulance for said child should the staff at ACE of Birmingham deem it necessary.

We, the staff at ACE of Birmingham, recognize our obligation to make our clients and their parents aware of the risks and hazards associated with the sport of cheerleading. Competitors may suffer injuries, possibly minor, serious or catastrophic in nature. These activities can be dangerous and can lead to injury. It is the parents who should make their children aware of the possibility of injury and encourage their children to follow all the safety rules and coaches’ instructions.

 

Date: April 26, 2024 

 

First Athlete's Name

First Name*

Last Name*
First Athlete's Date of Birth*
First Athlete's Contact Information

Parent/Guardian Name *

Parent/Guardian Cell Phone *

Relationship to Athlete *

Referral *
What activity are you participating in?*
First Athlete's Signature*
Second Athlete's Name

First Name*

Last Name*
Second Athlete's Date of Birth*
Second Athlete's Contact Information

Parent/Guardian Name *

Parent/Guardian Cell Phone *

Relationship to Athlete *

Referral *
What activity are you participating in?*
Third Athlete's Name

First Name*

Last Name*
Third Athlete's Date of Birth*
Third Athlete's Contact Information

Parent/Guardian Name *

Parent/Guardian Cell Phone *

Relationship to Athlete *

Referral *
What activity are you participating in?*
Fourth Athlete's Name

First Name*

Last Name*
Fourth Athlete's Date of Birth*
Fourth Athlete's Contact Information

Parent/Guardian Name *

Parent/Guardian Cell Phone *

Relationship to Athlete *

Referral *
What activity are you participating in?*
Fifth Athlete's Name

First Name*

Last Name*
Fifth Athlete's Date of Birth*
Fifth Athlete's Contact Information

Parent/Guardian Name *

Parent/Guardian Cell Phone *

Relationship to Athlete *

Referral *
What activity are you participating in?*
Sixth Athlete's Name

First Name*

Last Name*
Sixth Athlete's Date of Birth*
Sixth Athlete's Contact Information

Parent/Guardian Name *

Parent/Guardian Cell Phone *

Relationship to Athlete *

Referral *
What activity are you participating in?*
Seventh Athlete's Name

First Name*

Last Name*
Seventh Athlete's Date of Birth*
Seventh Athlete's Contact Information

Parent/Guardian Name *

Parent/Guardian Cell Phone *

Relationship to Athlete *

Referral *
What activity are you participating in?*
Eighth Athlete's Name

First Name*

Last Name*
Eighth Athlete's Date of Birth*
Eighth Athlete's Contact Information

Parent/Guardian Name *

Parent/Guardian Cell Phone *

Relationship to Athlete *

Referral *
What activity are you participating in?*
Ninth Athlete's Name

First Name*

Last Name*
Ninth Athlete's Date of Birth*
Ninth Athlete's Contact Information

Parent/Guardian Name *

Parent/Guardian Cell Phone *

Relationship to Athlete *

Referral *
What activity are you participating in?*
Tenth Athlete's Name

First Name*

Last Name*
Tenth Athlete's Date of Birth*
Tenth Athlete's Contact Information

Parent/Guardian Name *

Parent/Guardian Cell Phone *

Relationship to Athlete *

Referral *
What activity are you participating in?*
Athlete's Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the parent or court-appointed legal guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*
Parent or Guardian's Date of Birth*
Parent or Guardian's Contact Information

Parent/Guardian Name *

Parent/Guardian Cell Phone *

Relationship to Athlete *

Referral *
What activity are you participating in?*
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


One or more problems exist. Please scroll up.




Powered by  Smartwaiver - TRY IT FREE!